Hawaii made the top of the list as America’s healthiest state, while Louisiana was declared the unhealthiest.

Looking at data from the Centres for Disease Control and Prevention, the American Medical Association, and the Census Bureau, the rankings took into account everything from obesity and smoking to community and environmental factors, such as child poverty and air pollution, to public policies like immunizations, and health outcomes like cancer deaths and diabetes.

Here are all 50 states, ranked from healthiest to least healthy.

1. Hawaii has a low prevalence of obesity and smoking, and low air pollution, helping it clinch the top spot for the ninth time since the rankings began in 1990.

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2. Massachusetts held the spot as the healthiest state in 2017 but dropped down in 2018. The state has among the highest immunization rates and the lowest uninsured rate.

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3. Connecticut has one of the lowest rates of smoking in the country and has one of the lower percentages of uninsured people. But the state does have a higher rate of drug overdose deaths.

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4. Vermont has a low uninsured population and a low violent crime rate. However, in the last three years the drug overdose death rate in the state has increased by 32%.

5. Utah made it into the top 5 healthiest states based in part on having the lowest prevalence of diabetes, drinking and smoking.

6. New Hampshire rose in the rankings up from 8th in 2017. The state had among the highest rates of drug overdose deaths in the US and excessive drinking, though it had low levels of air pollution and a low infant mortality rate.

7. Minnesota has one of the lowest uninsured populations in the US and the lowest rate of cardiovascular deaths. The state does have a high prevalence of excessive drinking and a low immunization rate in children.

11. New Jersey has a low prevalence of smoking and has the third most dentists for its population. The state is also among the least physically active in the US.

12. California rose through the rankings from the 17th spot in 2017. California had among the lowest obesity prevalences and a low smoking rate. The state did have the most air pollution in the country, however.

13. North Dakota had the lowest levels of air pollution of the 50 states. Over the past three years, however, drug overdose deaths have increased by 207%

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14. Rhode Island has a relatively low rate of uninsured people and the most primary care doctors for its populations. However, its drug deaths have increased 70% over the last five years making it one of the states with the most drug deaths per 100,000 people.

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15. Nebraska has the lowest rate of drug overdose deaths in the country, though it is among the states with the highest rates of excessive drinking.

16. Idaho has a low violent crime rate and a low prevalence of diabetes among its citizens. The state does have the fewest primary care doctors for its population.

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17. Maine rose back through the rankings after dropping to the 23rd spot in 2017. The state had the least amount of violent crime in the country, and a relatively high number of mental health providers.

18. Iowa has one of the lowest rates of drug overdose deaths in the country, and a high insured rate. The state is among the states with the fewest mental health providers, though.

31. Delaware has among the higher rates of drug deaths in its population and is one of the states with the least amount of doctors.

32. Alaska is one of the states with the most physically active populations and a low prevalence of diabetes, though it has a high prevalence of smoking.

33. North Carolina has a high uninsured population, though it does have a lower rate of excessive drinking.

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34. Michigan has a higher rate of heart-related deaths, as well as a higher prevalence of diabetes. The state also has a higher rate of primary care doctors for its residents.

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35. New Mexico has among the lowest rates of cancer death among the 50 states as well as low levels of air pollution. However, the state has the second highest percentage of children in poverty and the second highest violent crime rate.

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36. Nevada has among the highest uninsured rates and lots of air pollution, though it has a lower prevalence of obesity.

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37. Texas is among the states with the lowest percentage of drug and cancer deaths. Texas has the highest uninsured rate in the country.

38. Missouri rose two places from 2017’s rankings. Missouri has a high rate of violent crime, contributing to its lower ranking.

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39. Georgia is among the least physically active states, and has some of the highest child poverty rates, and a relatively high percentage of uninsured people. On a more positive note, Georgia was among the states with a lower percentage of excessive drinking.

40. Ohio has a lower uninsured rate than other states. However, over the past three years, drug deaths increased 61% to 30.4 deaths per 100,000 people.

41. Indiana rounds out the bottom 10 states in part due to high rates of smoking and physical inactivity.

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42. Tennessee has a relatively high obesity rate, and a high prevalence of smoking. The state also has among the highest violent crime rates in the country.

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43. South Carolina has seen its obesity prevalence increase by 11% over the past 6 years to 34.1% of adults in the state. It has one of the lowest immunization rates for children.

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44. West Virginia has the highest rate of drug deaths in the US, the highest rate of obesity, and the highest rate of smoking. But it also has one of the highest rates of health insurance coverage in the country.

45. Kentucky has the lowest rate of physical activity among the 50 states, as well as a high prevalence of smoking.

46. Arkansas has some of the highest cancer and heart disease death rates of the 50 states, though it has a lower prevalence of excessive drinking.

Trong Nguyen/ShutterstockStreet light and tree line leading to State Capitol of Arkansas, a scale replica of the US capitol located in Little Rock. The main house of Arkansas government, famous landmark and tourist attraction.

47. Oklahoma has managed to decrease its air pollution by 17% over the last three years, though it still has a high prevalence of obesity and a high rate of physical inactivity.

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48. While Alabama might have a lower prevalence of excessive drinking, its lack of healthcare workers from dentists to mental health professionals for its population brings its ranking down toward the bottom.

49. Mississippi has the highest rate of heart disease deaths and a high prevalence of diabetes among its residents.